The Need for Strategies to Increase Immunization Levels
An important component of an immunization provider’s practice is ensuring that the vaccines reach all people who need them. While attention to appropriate administration of vaccinations is essential, it cannot be assumed that these vaccinations are being given to every person at the recommended age. Immunization levels in the United States are high, but gaps still exist, and providers can do much to maintain or increase immunization rates among patients in their practice. This chapter describes the need for increasing immunization levels and outlines strategies that providers can adopt to increase coverage in their own practice.
Vaccine-preventable disease rates in the United States are at very low levels. In 2011, only 4 cases of rubella, no cases of diphtheria, 36 cases of tetanus, and no wild-type polio were reported to CDC.
Given these immunization successes, one might question the continued interest in strategies to increase immunization levels.
Resurgence of some vaccine-preventable diseases such as pertussis, expanded recommendations for influenza vaccination and HPV vaccination, and gaps in sustainable immunization efforts highlight the need to focus on immunization rates. The viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to unprotected persons or imported from other countries, as demonstrated by pertussis outbreaks that occurred in 2010. Diseases such as measles, mumps, or pertussis can be more severe than often assumed and can result in social and economic as well as physical costs: sick children miss school, parents lose time from work, and illness among healthcare providers can severely disrupt a healthcare system. Although levels of disease are the ultimate outcome of interest, these are a late indicator of the soundness of the immunization system. Immunization levels are a better indicator for determining if there is a problem with immunization delivery, and this chapter will focus on increasing immunization levels and the strategies healthcare providers can use to do this.
Specific concerns about U.S. immunization levels and areas for further study include the following:
Childhood immunization rates are still suboptimal. In 2011, for example, only 84.6% of children 19 to 35 months of age had received four doses of DTaP vaccine.
For other age groups, immunization rates are considerably lower than those for early childhood. According to Behavior Risk Factor Surveillance System (BRFSS) data from 2011, a median of only 64.9% of persons 65 years of age and older received the influenza vaccine in the past 12 months, and 62.3% had ever received pneumococcal vaccine.
Rates of influenza immunization are also unacceptably low among healthcare providers, an important target population for vaccination. Typically, fewer than 70% of healthcare providers receive influenza vaccine.
Sustainable systems for vaccinating children, adolescents, and adults must be developed in the context of a changing healthcare system. High immunization rates cannot rest upon one-time or short-term efforts. Greater understanding of strategies to increase and sustain immunization levels is necessary in order to create lasting, effective immunization delivery systems.
Many strategies have been used to increase immunizations. Some, such as school entry laws, have effectively increased demand for vaccines, but the effectiveness of other strategies (e.g., advertising) is less well documented. Some proven strategies (e.g., reducing costs, linking immunization to Women Infants and Children (WIC) services, home visiting) are well suited to increasing rates among specific populations, such as persons with low access to immunization services.
One key to a successful strategy to increase immunization is matching the proposed solution to the current problem. Although a combination of strategies—directed at both providers and the public—is necessary for increasing and maintaining high immunization rates, this chapter focuses on immunization strategies for healthcare practices and providers.
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